A new drug for high blood pressure has been found to be an unexpected permanent cure for a common cause of the condition – a breakthrough that could help over a million Brits.
The medicine, called baxdrostat, was designed to work by stopping the body from making a hormone called aldosterone, which raises blood pressure.
A new study has found that it also has the surprise effect of killing the cells that overproduce the hormone, located in the adrenal glands, on top of the kidneys.
The death of these cells is a great benefit for a subgroup of patients: for one in 10 people with high blood pressure – or hypertension – the cause is tiny benign tumours in their adrenal glands making too much of the hormone.
‘From chronic treatment to cure’
Currently, hypertension caused by these tumours can be cured by surgery to remove the affected adrenal gland – although sometimes people do not know if they have the tumours.
Now, a small study has suggested that taking baxdrostat for several months kills off the hormone-producing tumour cells – and the effect could be permanent.
“It’s very exciting,” said Professor Morris Brown, a heart specialist at Queen Mary University of London who was involved in the study – and predicted the benefit based on the drug’s animal trials over 10 years ago. “It’s been my hope that one day we would go from chronic treatment to cure.”
Nearly a third of adults have high blood pressure – meaning the potential cure could benefit over a million people.
An unexpected finding
The finding, published Saturday in The New England Journal of Medicine, came from an analysis of a larger trial done to gain approval of baxdrostat as a standard blood pressure medication that is taken forever.
The treatment was approved in the US this year for people whose blood pressure is still dangerously high despite taking two or more other drugs. It is likely to become available in Britain next year under the same conditions, with the National Institute for Health and Care Excellence (Nice) currently deciding if it will be offered on the NHS.
People with this kind of “stubborn” blood pressure are more likely to have the adrenal gland tumours as the cause.
The baxdrostat approval trial was due to last three months. At the end of that period, 14 patients who had experienced large improvements – with an average fall of 25 millimetres of mercury in their systolic blood pressure – were allowed to continue on the drug.
They carried on taking it for between six and 12 months, then stopped.
A daily pill to replace major surgery
So far, their blood pressure has continued to stay at the lower level for up to two years of follow-up, the analysis found. And one person of the group has been off the drug for three years, said Brown.
“Longer follow-up may justify a claim that a finite course of medication leads to infinite cure,” he said. “That’s the hope. Clearly we need a larger study, which is now under way, to really prove this.”
The drug may be killing the tumour cells because when it blocks production of the hormone aldosterone, this generates energetic compounds – called reactive oxygen species – that are “very harmful to the cell”, said Brown.
Mason Freeman, professor of medicine at Harvard Medical School also involved in the study, said: “This follow-up study has generated some extraordinary and unexpected findings.
“The sustained remission offers the exciting possibility that many patients with [adrenal gland tumours] may be treated with a once-a-day pill, perhaps for a limited period of time, and obtain similar benefits to what we now achieve only after major adrenal surgery.”
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